STORY ARCHIVE

GHB

This Catalyst report investigates the newest party drug on the dance scene GHB. It’s caused several deaths, many more to overdoses and its use is growing. With hospital emergency wards being overwhelmed by severely overdosed GHB users, this story explains what exactly is GHB doing to users. It turns out that it’s a naturally occurring substance in the mammalian brain. But it depresses the central nervous system and slows breathing, heart rate and lowers your blood pressure. People who overdose on GHB have to be intubated and ventilated, so every weekend hospital emergency wards are being pushed to the limit by overdose cases - taking up places on ventilators. But one doctor in Adelaide may have the answer to battling this drug, and freeing up hospital beds. It’s an out of favour drug called physostigmine, with the ability to bring people out of GHB coma in minutes.

TRANSCRIPT

Narration:There’s a new party drug sweeping Australia. Its use is on the rise, and so are overdoses.

All sorts of people are taking it, in clubs, bars or even at home.

Paul Dillon: We really don’t know anything about how many people are using it. We know it is definitely becoming more popular.

Narration:The drug is GHB or gamma hydroxy butyric acid. It’s also known as GBH, or grievous bodily harm, and with good reason.

David Caldicott: Well it’s an anaesthetic agent so we use it for example to put people to sleep. I could take your appendix out by giving you a dose.

Narration:Taking GHB is living on the edge.

Just a few drops is the difference between a safe dose and an overdose.

Every weekend emergency wards around the country are filling up with patients who misjudge their dose.

Staff and life-saving equipment are being pushed to breaking point. So one doctor in Adelaide is looking for a better way to deal with the crisis.

Dr David Caldicott is the Emergency Research Fellow at Royal Adelaide Hospital.

He’s seen a disturbing increase in GHB overdoses over the last few years. He says it’s a big problem, particularly in Sydney.

Paul Willis, Reporter:And how many cases are we looking at?

David Caldicott: Oh they’re looking at ten a week easy.

Paul Willis, Reporter:What’s the main problem for an emergency ward dealing with GHB cases?

David Caldicott: Well as you can see here we’re a new emergency department and we have 4 resuscitation bays and this is one, and one of the things that many of the GHB cases require is intubation and ventilation. To do that we need an endotracheal tube, which is simple plastic tube, and we need a ventilator, which will breathe for our patient when they stop breathing as they often do with GHB overdoses. But as you can see with only four if you have multiple overdoses coming say for example from a nightclub or a rave all of a sudden you run into a lot of trouble ventilating your patients

Narration:This is the frightening possibility that hospitals all around the country are facing.

GHB hasn’t always been illegal. It was used above-board for many years as an anaesthetic in hospitals.

So how did a drug that was once used to do good in our hospitals, end up creating a crisis?

In Sydney, Paul Dillon from the National Drug and Alcohol Research Centre has been tracking GHB and its uses before it was made illegal.

David Caldicott: It was really introduced in Australia through the body building fraternity who had seen some research that was conducted in Japan, which suggested that GHB promoted deep sleep. Deep sleep could actually reduce fat and create muscle. So of course it was particularly attractive to the bodybuilding group.

Narration:In the 1990’s, GHB started to trickle into the hands of party-goers. That’s when people started overdosing, and it was banned in Australia shortly afterwards.

David Caldicott: As soon as it was banned it became extremely popular, which is what we tend to find with these sorts of drugs.

Narration:The GHB people are buying now is no longer pharmaceutical grade. It’s being made from solvents, and this has made David’s problem even worse.

David Caldicott: These drugs or chemicals are usually taken from industrial sites and therefore not prepared for human consumption.

Narration:GHB is being taken by people like Sarah, who it takes most weekends.

Sarah:Once it sort of kicks in to like a full effect, you’ll get a bit of blurred vision and you know, moving around, you feel you’ll get a bit off balance. It gives you that sort of lowered inhibition where you just feel good and you know you just relax, yeah.

Narration:Sarah always colours her GHB so no one mistakes it for water, and she’s careful to measure out exact doses before she takes it.

Sarah: There’s rules that you go by to taking GHB. The effects of it are quite enjoyable when you have it like responsibly.

Narration:But misjudge your dose by a millilitre, and you start feeling the effects of a powerful anaesthetic kicking in.

Sarah:One time I’ve had it and I felt like if I really wanted to I could probably sit down in a corna and go to sleep.

David Caldicott: The breathing will slow to a point where the oxygen levels will drop critically in the blood The pulse decreases, the blood pressure decreases.

Narration:Just a few drops more and sleep becomes a coma.

David Caldicott: The brain is effectively starved of oxygen and on top of that the muscles which support the airway can go floppy or flaccid and the commonest cause of death from GHB and GHB like compounds is respiratory arrest.

We had an episode in a bar about eighteen months ago where instead of chugging shots of vodka they decided to chug shots of GHB and we had seven simultaneous presentations and that threw our department into absolute chaos purely because we had to try to maintain the airways of all of these people at the same time.

Narration:The hospital couldn’t go on like this for much longer. They had to find another way of treating GHB overdoses that didn’t tie up the precious ventilators.

David began scouring through old medical journals, hoping that something in the history of GHB might give him a clue.

Then he stumbled across an old, forgotten paper, written almost thirty years ago.

In the 1970’s, two anaesthetists from Dunedin Hospital in New Zealand were using GHB as an anaesthetic, and they were trying to find a way to reverse its effects.

They came across an old drug called Physostigmine, which they suspected might do the trick.

When they tried it, their patients woke up after a few minutes instead of several hours.

But David had a big problem with physostigmine. Over the years it had gained a nasty reputation for causing seizures and even death.

David Caldicott: So this is physostigmine. It comes as a solution in a vial.

Paul Willis, Reporter:And it’s had a bit of a bad rap itself though physostigmine?

David Caldicott: It has but going back into the medical literature the foundations of its bad reputation are very shaky indeed.

Narration:He double-checked the literature and finally he was sure that the criticisms of physostigmine were based on flawed research.

Then came the moment of truth. He decided to try physostigmine on GHB overdoses.

Paul Willis, Reporter: Were you nervous about using Physostigmine?

David Caldicott: Of course. We didn’t know what would happen.

Narration:To his great relief, it worked.

David Caldicott: Quite how well it worked surprised us tremendously and that was definitely a grinning moment.

Narration:So far David has administered physostigmine to GHB overdose patients who are partially awake. Four out of five of these patients have come round without needing to be ventilated.

For the Royal Adelaide Hospital, it’s a huge leap forward.

This new approach won’t stop the overdoses, but it could save lives and will save precious resources in our already stretched emergency wards.

Paul Willis, Reporter:What would you say to people considering taking GHB?

David Caldicott: Try another drug. There are lots of other drugs. I don’t advocate drug use but please if you have to take a drug you know use something else. This is an anaesthetic agent. I’m not a drug Nazi but if I was to ban anything it would be GHB and all of its precursors.

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Scott - 10 Feb 2013 7:35:21am

A disturbing and inaccurate pieve of misinformation on a rather harmless drug. This Dr needs to go back to school and learn some facts before molesting patients with tubes and endangering their lives with dodgy physostigmine. GHB dose curve was grossly exaggerated. A millilitre too much and you would only notice extra effect in lab mice maybe? The story and this Dr set out with an intention of deceiving the public and to scare users with threats of molestation and being guinea pigged with deadly and unnecessary chemicals. Perhaps Catalyst could do a story on Xyrem and interview some patients who's lives have been cured of EDS thanks to the miracle of a drug. In the process maybe you will notice Xyrem is GHB and the patients take it alone every night to the dose where they OD and sleep fine with no tubes in their airways or Dr's next to them point needles full of deadly seizure causing compounds.And there you have 2 sides to a tale.Disappointed in the ABC for showing is biased one sided story.